Under The Knife

Dr. X2

I walked into the restaurant and sat at the bar, figuring it wouldn't be long until the person I was waiting for showed. Since leaving my hotel, I'd been feeling a sense of dread, excitement, and déjà vu. Five years ago, I met with a man I called "Dr. X", one of the leading figures in the steroid underground. Tonight, I'd be doing the same. Last time, I had to jump through hoops, seeing meetings canceled and conditions changed, and when we finally did meet face to face, he was wearing a disguise. There were no such concerns this time, as if men like Dr. X had undergone the same transformation as their drugs. Things were more advanced, clearer (no pun intended), and done much more out in the open.

Since I last sat down with one of these men, baseball had come a long way, having instituted a testing program that had driven out most of the steroid users, and had pushed that percentage of hardcore users to more advanced products. In driving out deca-durabolin and boldenone, baseball had ushered in an era where the low end picked up things at the local GNC, hoping that the unregulated, hype-driven industry wouldn't spike their latest creation to get results, while the upper end-those with the money, knowledge, and connections-would deal with the underground. Drug usage on the whole was, I believe, down, but the idea that baseball was drug-free was simply fiction. Some had moved on to whatever this month's "clear" was, staying one step ahead of the testing regime, or using undetectable substances, like HGH, insulin, and now, something new.

But this time, I was meeting with another figure from the steroid underground, and-to use Mark McGwire's famous phrase-we weren't here to talk about the past. He had something new, something powerful, and something that he said could make testosterone obsolete. As he joined me in a booth, he didn't appear nervous, didn't worry about who was sitting near us, and he wasn't disguised in any way. His only guarantee was my promise of anonymity, though I think his ego might not care if his name were to leak out. We'll call him "X2." He's a master at putting together performance-enhancing programs built around legal and extra-legal methods, and he's one of the best because his programs are both effective and undetectable. In previous conversations, he had hinted that he had the next big thing, and that's what I wanted to learn more about.

As he sat down, the talk naturally started with baseball. I began taking notes. "So here we are," I said, looking at the menu and glancing around at the room. "We're five years into the testing era. Positives are down, home runs are down... so it's working right?"

X2 smiled. "Well, home runs are down, but I don't think that drug use is down. People point to positives being down, but that's because the ante has been upped. Players can't just use whatever they want any more. It was the Wild West just a few years ago, but guys are just being smarter about it now."

I nodded. "I'd agree. All the statistical studies showed there wasn't a big effect, but that's neither here nor there. So what are the smarter guys doing now? What's the next THG?"

"Probably SARMs, which aren't even on the legitimate market yet, but you can find on the black market. They're a nightmare for testing officials."

I'd heard a bit about SARMs (Selective Androgen Receptor Modulators). The word on the street was that they had a powerful anabolic effect, but that it came from a completely different mechanism. "What do they do? I mean, how do they work and how effective are they?"

"Chemically, they bind to the androgen receptor, just like testosterone, and signal the body to build more muscle and strength. It's like testosterone without the testosterone. Actually, the testosterone analogy is apt, because they're every bit as effective as [testosterone]."

That was a big claim to be making. "Sure but that's the goal of every steroid or supplement though, isn't it? How close to testosterone is it? If testosterone is 100, what's this SARM? Even the various testosterone injectable forms aren't 100."

X2 jotted a few things down on a napkin. Just numbers. "Testosterone has an anabolic rating of 100, and the anabolic rating for SARMs is reported in medical studies to be between 97-103. Testosterone is 100 because it's the gold standard, and all steroids are measured against it on that scale."

"Firsthand?" I asked. In answer, he set a small bottle on the table. It was your basic tinted glass bottle, a dark blue with a medicine dropper top. It sat on the table with the salt and pepper, next to my iced tea. "You've used it?"

He nodded, as if I'd asked a stupid question. "Yes. On an ethical level, I wouldn't be telling athletes to use it if I hadn't already."

"That's both some big confidence and, for many people, strange ethics."

He laughed. "If i ask you to jump off a bridge, you can be sure that I've jumped off. Plus, you know all your friends are doing it."

I jumped in. "Let me pause you there. The worry about steroids has always been that people, especially teenagers, thought everyone was doing it and that they had to to keep up. Bonds supposedly started because he thought McGwire and Sosa already were. but we both know the numbers were never that high. Canseco said 80 percent, but I don't even believe 50 percent is accurate."

He shook his head. "I think the number in baseball is high. Not Canseco, but high."

"I won't disagree, but I think it's like marijuana use in high school. A lot experiment, but a few use."

He jotted something on the napkin I couldn't quite see. "The numbers-and I'm talking correlative figures here-don't support the idea that teenagers are emulating professional athletes in terms of steroid use. If the 'steroid era' in baseball could be counted as an upswing in steroid use, you can look at those years in teen use, and there isn't a corresponding upward trend. Kids nowadays love their MySpace and Facebook. Both of those sites have had active steroid busts on them, where members were selling to other members."

Good, now Congress can blame a series of tubes, cables, and wires for the problem. "Back to the SARMs. Your athletes are already using this?" I knew this was the case, but I needed to hear how he was setting up programs. "And if you're telling your athletes to use it, that means of course that athletes are already using this, something that most people haven't heard of."

He paused and took a sip of his water. "Yes, it has been in the literature for several years, well before this last Olympic games, though it became readily available in the United States last winter. December, I believe." Just in time for Christmas giving... or baseball's offseason. "At that point, we starting using it for my athletes that need to beat tests. I have an athlete who is coming off a two-year suspension, and they're playing a big role in his drug use. He was suspended for steroids, but that was before me."

I smiled. "Nice to see recidivism is at least educated. What have been the results?" Instead of answering, he took out his phone, showing me a picture on his Blackberry of a giant of a man. Clearly a bodybuilder, this guy was massive. "OK, no question about that. Now, if you're saying that in some cases its better than testosterone, why wouldn't you use it more broadly, even in an untested situation?"

"Practical reasons, actually. It isn't widely available, and since there are limited places to get it, I typically don't use it in place of testosterone. A low dose of testosterone is still undetectable. For example, 100 milligrams of testosterone propionate, administered every other day, will keep my test/epi ratio under 4:1, which is the accepted range, and my total testosterone gets to 958. 1000 is the accepted normal range."

"Sounds like more self-experimentation."

He nodded. "I've already jumped off the bridge." Some might call that a very apt analogy."

"What about side effects?" I asked. "Would George Costanza be worried about shrinkage?"

He laughed. "It doesn't convert to estrogen or dihydrotestosterone, and it doesn't affect natural hormones. I can tell you first-hand that there's no shrinkage," he said, eyeing the server.

The supply question really interested me. THG was effective because few places knew of it, let alone had the ability to synthesize it. With a bit more complicated chemistry at its heart, SARMs might be held back for a while by supply. X2 agreed, noting "We go through SARM droughts. There's none for sale right now in the States, but a shipment will arrive in 11 days. Don't get any ideas, because it's reserved!"

So it was perhaps self-limited. "We have a limited supply and presumably high cost. That should keep it limited to a very specific population."

He paused before agreeing. "It's more expensive than testosterone, but not prohibitively expensive for professional athletes. It's far cheaper than growth hormones. It's about as expensive as Lr3-IGF1, another undetectable performance enhancer." Lr3, the latest form of IGF-1 (insulin growth factor) had been around for a while, with most athletes abandoning it for the cheaper and more available insulin. WADA has been hinting about an IGF-1 test, though they've been talking about an HGH test for far longer, and it's still not widely available or even broadly accepted.

"Tell me, what kind of cost are we talking about? Most people have no idea what any of this costs."

He reached out and held the bluish bottle up. He unscrewed the top, drew some into the dropper and put some on his fingertip. The drop sat there, looking all the world like flaxseed oil. That wasn't going to help things. "This bottle? It will run you about seventy-five, maybe a hundred bucks."

"That's nothing," I said, stunned. "I could afford that, if I was ready to jump off that bridge."

"It's not expensive," he said, wiping his finger off and putting the bottle back in his pocket. If he was carrying it around like this, it wasn't just to show it to me. It had to be clear of the refrigeration issue that made HGH and IGF so tough to carry. "It's just more than testosterone. That's a concern for bodybuilders, people who aren't making the baseball or NFL money and need to megadose. It's expensive to be undetectable. Thousands for hormones, hundred for SARMs, more hundreds for IGF-1, and I like to keep costs low. Barry Bonds was a notorious cheapskate. Athletes, even the very rich ones, balk at three grand a month on a drug bill."

"Cost and availability is why we're seeing minor leaguers and Latins go 'old-school' and get busted for Winstrol. I mean, I saw a bottle of Winstrol at the pharmacia when I was in the Dominican Republic last month, and that was at a resort!" He nodded, so I continued. "The one I've seen most inside of baseball has been insulin, and that wasn't even noted on the drug report that MLB made public recently. We have economic incentive, plus opportunity, to do it without being detected. Thousands of dollars in drug bills-and your consulting fee, of course-can lead to potential millions."

"Yes," he said, pointing at me. "We're really talking about incremental gains here. Added up over several seasons, that can create superstars. You don't go from Little Mac to Big Mac in a year, but look at the progress he made yearly, and those incremental gains were worthwhile, and hardly the gains you get from andro!"

McGwire may not be here to talk about the past, and while we may never know about his usage, theories abound. I wanted to test one of mine. "I've always been convinced that McGwire started using not to get big, and certainly not as early as what Canseco said, but to try and recover from the plantar fasciitis."

He didn't hesitate. "Wouldn't you? People want athletes to be noble and fall on their swords instead of taking drugs and getting over injuries, yet they take their Lipitor and Viagra to get over whatever ails them. Sports is the only job in the world where you're denied access to medication that can help you recover from job-related injuries. Yet somehow, cortisone shots are noble. Schilling gets a cortisone shot, plays through the pain, and is a hero."

I pointed to his pocket. "Limited supply. Reasonable cost. We'll see this in baseball this year, won't we?"

"No doubt." Looking into his eyes, I could see that he had none. It wouldn't surprise me if he knew names. "Everyone knows a guy who knows a guy. They're new and sexy and becoming a buzz word with the strength guys. McNamee or Alejo would know SARMs if they were still doing this." (I guess he didn't realize Bobby Alejo was back in the game, recently hired by Oakland.)

"But if it's a guy that knows a guy, like it was with steroids, isn't this just setting things up for another BALCO?" I asked.

"Not a BALCO, but smaller BALCOs. A couple rogue chemists and performance specialists working together with a select few athletes. We'll see cells like this popping up. We have already. The East German doping program was too big, and that's why it got busted. BALCO was too big and too loud, but little clusters of coaches and athletes teaming up with chemists... that's the future."

"Sure," I said. "We saw it before, but everyone treated BALCO like it was a singularity. Conte didn't get that he should keep his head down. Is this SARM thing the intermediate step between the steroid era and the genetic doping era? I thought Beijing was going to be where we had the freak step out and look like that cow."

He smiled. "I don't know if we necessarily need to go that far. You've seen those gene-doped rats and the Belgian bulls. They're not very athletic. It's crude at this stage, so we need another step. Something before that level, but above what we have now. That's SARMs."

"But what if your guy doesn't know the right guy or right cell with the right stuff?" I asked. "I mean, GNC is already selling something called 'SARM Extreme.' Beyond that, there's a shelf life for undetectable, since you can't market something and keep it a secret. How long is it before Don Catlin has a test for SARMs the way he did for THG?"

"Yeah, SARMX by MHP. That's nothing but a waste of money. The testing? Catlin? I like that guy a lot, actually. He realizes that he isn't there to catch every cheater, but rather a few here and there, and put up a good show that sports are clean. Clean-ish. How long? They're already trying to figure one out, and some studies have identified metabolites. Just remember, the side of the street I work on, we're usually a step ahead. If they come up with a test they're comfortable using, then a molecule here or there and we'll be OK again. I'm not convinced they're particularly close either. They've said they're close on an HGH test since Bush was President. The first one, I mean. The real problem is that now, anyone who is good is suspected of drug use. If you put together a 75 home run season, that would mean you'd have to come correct and make sure 100 percent of your drugs are undetectable. Usain Bolt was suspected of doping as soon as he set a world record, and that's the new trend."

The meal was over, and neither of us were dawdlers. I had covered everything I'd hoped to and more in the hour I had. "So let me sum this up: You've got a drug that's as effective as anything you've ever had in your arsenal. It's undetectable, has no side effects, and only a few people have access to it."

He nodded and smiled. "Yes, and you know that insulin and IGF are in that arsenal too. IGF has been available on the black market for over a decade. Insulin is available at Walgreens."

"In other words, it's going to be a good year for the black hats?"

He laughed again. "The black hats always have a good year!"

With that, X2 got up to leave. As the waitress came with the check, she watched him leave, as I could tell many people were doing. She turned to me and asked "Is he a football player?" I just sighed. "Something like that."

I would be curious to know if sarms are really that close to the quality of testosterone, or if x2 is just trying to gain a few clients with this interview. Also, I would be curious to know how this compares to the anabolic rating of past popular drugs like THG. Can you shed some light on this, Will?

It's also hard for me to believe the cost is that low if it's that good and that hard to come by. That's not how supply-demand curves work....

The studies on SARMs do show that high an anabolic rating. I'll see if I can get the number of THG.

I think the price is as high as it can be and still sell. Note that athletes are cheap and right now, I'm relatively sure most of this is going to bodybuilding and powerlifting. Compared to the cost of "regular" steroids, its very high.

There's no ranking on THG that I could find. The rating is done on rats, so not sure how applicable it is anyway, but it's a guideline. Given THG's close chemical cousins, it's probably high 80s, low 90s.

Will, thanks for the article and for once again being the most clear-headed and informative voice on the subject of PEDs.

My question is: does MLB retain their drug test samples or discard them immediately following analysis? I'm curious whether athletes may be dissuaded from using SARMs by the threat of retroactive testing if a SARMs test becomes available in the future.

So, if marijuana is safe to use and has no side effects, why is anyone trying to stop its use?

There's just no simple answer to your question. There are lots of motivations for banning steroids, not all of them are shared by all the people that want them banned. Some people are mistaken about the dangers. Some people are afraid of sending their children mixed messages about drugs. Some people feel that it harms the integrity of sports. Some people thing drug use is intrinsically bad. And so forth.

(By the way, I'm not convinced by X2's assertion that there are no side effects. That's the sort of thing that should be determined by careful scientific testing, and I don't know if that has happened yet. The above comment should be read as speaking hypothetically that X2 is accurate.)

Good stuff, thanks. A question: "It doesn't convert to estrogen or dihydrotestosterone, and it doesn't affect natural hormones."

The impression I got is that SARMs are acting as androgen receptor agonists, i.e., they bind to the receptor and are "like testosterone w/o the testosterone." How confident is X2 that SARMs don't screw up normal hormone levels? I don't know much about the mechanism of normal testosterone regulation, but it seems entirely reasonable to assume a negative feedback loop based on the level of androgen receptor signaling. If that's the case, SARMs would depress natural testosterone production if given at high levels for long enough. I find it unlikely that the body can recognize the testosterone-like effects without also deciding to shut down normal testosterone production...although the precise pharmacological profile of SAMRs versus testosterone may be different. Is my intuition wrong, or is X2 hyping his product? Or is there something more complicated going on?

All moralizing aside, the lesson from Vioxx should be a certain amount of caution regarding how difficult and expensive it is to determine whether a new pharmaceutical is safe for long term use.

Why wouldn't Selig learn from past mistakes and get SARMs out in the public spotlight right now? Make everyone aware of it, which would almost certainly draw a public uproar before we see the bulg in stats again.

Do you know of any interview or questions Selig has fielded on this subject and what his comments have been? You would think if he nipped this in the bud then there would at least be some kind of fear struck in the hearts of players that would be on the fence about using SARMs.

They can't stop those guys that always look for the pharma-edge but he might be able to minimize the "try it once" kind of player.

If you're Selig, do you really want to get up in front of the cameras and drone on (which is all he's good for in a public setting) about these drugs which are undetectable... casting the validity of the sport back into question, during a nasty recession no less?

I mean... what's he supposed to do? Lobby the owners to put serious money into research for testing is probably the best he can do.

It depends on what your goal is. Baseball's policy has been about driving out steroids, then amphetamines and for the most part, it's done that. Football's policy has been about controlling PR and it's done that. With baseball, by driving out steroids and amphetamines, it's made some go "clean" and some got more creative. I'd say overall the numbers are way down, so the program has to be considered a success.

If you think of this as a speed bump, then yes, people are driving more slowly and cautiously where formerly, they sped around recklessly. I'd say that's a positive, but it's also very unreasonable to expect zero. Going from roughly 5-6% to below 1% sounds like success to me.

Some of the decrease in positives may well be guys who have been "scared straight."

As this (outstanding!) article implies though, another way that positives are being decreased is that some guys are likely just switching from Deca and Winstrol and T and THG to IGF-1 and SARMS and the now rather old-hat HGH.

Serious question: Does SARMS stack well with HGH? I've read that stacking anabolics with HGH is to sports what gamma rays are to Marvel Comics. Just curious if there's any street lore or better, medical data on stacking some of the newer goodies.

I think Evan raises a good point. I would rather see an honest discussion about steroids and their safety than just paint all of them with the same brush. And like Dr X2 asked, why is cortisone OK when steroids are not?

If player's health is really what we are concerend about it would seem that creating a regulated, supervised and legal steroid market is a lot better than this black market, "trust me it works" alternative we have now. Not perfect but better. It also seems a bit hypocritical of us as a society to worry about safety with steroids but cheer on NFL players when we know many of them will suffer long-term, dibilitating health problems as a result of just playing by the rules of their game.

I have 2 sons and if forced to choose I would rather they dable in steroids and play baseball then have a career in the NFL. Though I would prefer they follow my footsteps and sit safely behind a desk.

I don't understand why you wrote an article like this. Just the thought of you being so close to such a bad part of the beautiful game of baseball doesn't make me feel all that great. I understand that this might have been a way to inform the Prospectus readers about the steroid issue, but I feel like articles like this will harm baseball more than help it. It was a very good article, but I hope that it's the last one where you get anywhere near the people who help people cheat in baseball, and trivalise the game that we all love.

I liked the article, but I just had some issues with the subject. Nothing against you, you're a great writer.

I certainly didn't test it, but it's my understanding that the sample is reasonably portable. You treat it like any medicine - store in cool dry place - but that the strict refrigeration isn't necessary.

There was a middle school someone wrote to me about after The Juice that had a refrigerator in the nurses office where the kids kept their HGH. At any given time, there was about 50k of HGH in that fridge.

Safer? I'm not sure but there are medical studies on this which we've never had on steroids. I'm specifically not giving too much information here because I don't want to lead someone to this, but the FDA knows about this drug, though it is being developed for other uses, much in the way that HGH is available for ideopathic short stature.